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2 What is Pneumonia? Pneumonia is an inflammation of the lung tissue, normally caused by an infection. This infection is commonly caused by a bacteria or virus. In patients who are well, treatment with antibiotics can be given as an outpatient and usually leads to a full recovery. In patients who are unwell or at higher risk, recovery can be longer, and sometimes requires hospital admission. In severe cases, pneumonia can be life threatening. How do you get pneumonia? Pneumonia is caused by breathing in organisms (bacteria or viruses) carried in the air. In healthy individuals, the sputum (phlegm) captures these and the immune system removes them without causing lung infections. In those who are in poor health, for example those who are elderly, frail or already have a pre-existing lung condition, this may lead to pneumonia. Other people at risk include those who have a low immunity including smokers, heavy alcohol drinkers, those on immunosuppressive medication and those with other coexisting illnesses such as diabetes. What are the symptoms? The most common symptoms include fever, shivers, cough and sweats. There is often a decrease in appetite, a feeling of lethargy and a lack of energy. Headaches, dehydration and muscle aches can also occur. Other symptoms include expectoration of green/brown sputum, which can rarely become bloodstained, breathlessness, or heavy breathing, or chest pain or tightness. Not all these symptoms have to be present and some may not occur at all. How is pneumonia diagnosed? Diagnosis is made from a clinical examination of the chest alongside a chest x-ray that will show areas of shadowing at the affected part of the lung. There may also be low oxygen content in the blood. Other indicators include a rise in the inflammatory markers of the blood tests. The sputum can also be collected and tested for specific organisms, which can help guide antibiotic choice. 2

3 How is pneumonia treated? At home: If you are not admitted to hospital, or after you have been discharged from hospital: please take the full course of antibiotics, as this is the most important part of the treatment. Even if you are feeling better, finish the course. drink lots of fluids (8 glasses a day), this helps loosen secretions and mucus/phlegm in your lungs and keeps you hydrated. Water or pure fruit juice is good for hydration. Avoid alcohol while unwell. It is best to limit your intake of tea or coffee unless it is decaffeinated as caffeine can increase dehydration. getting rest is important, but once you are improving you can gradually increase activity. painkillers such as Paracetamol or Ibuprofen can be taken to reduce fever and relieve chest pains. Coughing may last for a few weeks as the infection clears and your lungs recover. In hospital, the following measures are used: Oxygen to help relieve the effort of breathing and increase supply to the lungs. Painkillers and medications to reduce fever,such as Paracetamol. Fluids to help rehydration - this is done intravenously through a drip if the infection is severe. Antibiotics: these are often penicillin based but alternatives can be given for those who are penicillin allergic which work just as well. These can be given orally but often need to be given intravenously if the infection is severe. In most cases, pneumonia can be successfully treated with the above measures. Less commonly, complications may occur including fluid accumulating in between the lining of the lung and the chest wall (empyema). Other complications include collapse of the lung or holes in the lung (abscess) where the infection is present. In these situations longer stays in hospital may be needed and further treatment required. 3

4 Artificial ventilation If the infection is very severe it can cause extreme breathlessness to the point where the body is unable to provide adequate oxygen for the body s needs. In this situation, if the patient s pre-existing health is good enough they will be offered invasive ventilation. This means a tube will be inserted into the lungs through the throat and artificial ventilation provided by a machine, on the Intensive Care Unit. What happens after being treated? Symptoms Often start improving after 3-4 days of treatment. The temperature should start settling within 48 hours of starting antibiotics. There is usually no need to stay in hospital for the whole period of antibiotic treatment. Once the temperature has settled, the remainder of recovery can happen at home. Some people may have a persisting cough after treatment. If this lasts more than 3 weeks please see your GP. Although many people recover within a few weeks, some may take longer to get back to full activities, as much as a few months. Time off work We recommend staying off work and resting for at least one week after the antibiotics have finished and possibly longer depending on how quickly the energy levels come back to normal. A fitness to work certificate for time off work can be obtained from your GP if needed. Follow up Chest X ray In those who have had chest X-ray changes noted, it is recommended that a repeat chest x-ray is done around 6 weeks after the initial infection as it can take this long for the X-ray appearances to fully resolve. On discharge we will book you a X-ray in 6 weeks at your nearest hospital in Buckinghamshire. If you do not receive an appointment then please contact our secretaries in the chest department on the numbers shown on the front of this leaflet, or ask your GP to give you a form. Once you have had the x-ray done we will contact you by phone or letter to confirm that everything has cleared up; if you do not hear from us within 2 weeks of performing the x-ray, please contact the chest department. 4

5 What do I do if I get worse again after I leave hospital? If your temperature comes back again despite antibiotics, or you get worsening breathlessness or chest pain, please see your GP or return to the Accident & Emergency Dept (A&E) at Stoke Mandeville Hospital where you will be re-assessed. However if the only symptom you have is a lack of energy then this is likely to be the post-pneumonic fatigue that many people experience, irrespective of their age or pre-existing illnesses. In this case you must rest more and listen to your body - it will tell you if you are doing too much. How can pneumonia be prevented? General measures include early recognition of symptoms, so appropriate medical advice can be sought early, limiting close contact with others that are unwell and reducing inhalation of harmful substances, in particular smoking. In those that are at higher risk of developing chest infections, such as asthma, COPD (Chronic Obstructive Pulmonary Disease) or bronchiectasis sufferers, then early antibiotic therapy and vaccinations against common organisms including influenza and pneumococcus are recommended - these can be organised with your GP. In many patients with long term lung conditions who suffer frequent chest infections, we recommend keeping rescue antibiotics at home. If you think this applies to you please discuss this with your GP. 5

6 For help with stopping smoking, please contact the Buckinghamshire smoking cessation clinic on or visit the Website: How can I help reduce healthcare associated infections? Infection control is important to the well-being of our patients and for that reason we have infection control procedures in place. Keeping your hands clean is an effective way of preventing the spread of infections. We ask that you, and anyone visiting you, use the hand sanitiser available at the main entrance of the hospital and at the entrance to every clinical area before coming in to and after leaving the clinical area or hospital. In some situations hands may need to be washed at the sink using soap and water rather than using the hand sanitiser. Staff will let you know if this is the case. Follow us on If you require a translation of this leaflet please call xxxxx xxxxxx. Author: Issue date: Review date: Dr Mitra Shahidi October 2013 October 2015 Leaflet code: PNE-001 Version: 2

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